title: Emergency department-based brief intervention to reduce risky driving and hazardous/harmful drinking in young adults: a randomized controlled trial.
abstract: BACKGROUND
  Risky driving and hazardous drinking are associated with significant human and economic costs. Brief interventions for more than one risky behavior have the potential to reduce health-compromising behaviors in populations with multiple risk-taking behaviors such as young adults. Emergency department (ED) visits provide a window of opportunity for interventions meant to reduce both risky driving and hazardous drinking.
  
  
  METHODS
  We determined the efficacy of a Screening, Brief Intervention, and Referral to Treatment (SBIRT) protocol addressing risky driving and hazardous drinking. We used a randomized controlled trial design with follow-ups through 12 months. ED patients aged 18 to 44 who screened positive for both behaviors (n = 476) were randomized to brief intervention (BIG), contact control (CCG), or no-contact control (NCG) groups. The BIG (n = 150) received a 20-minute assessment and two 20-minute interventions. The CCG (n = 162) received a 20-minute assessment at baseline and no intervention. The NCG (n = 164) were asked for contact information at baseline and had no assessment or intervention. Outcomes at 3, 6, 9, and 12 months were self-reported driving behaviors and alcohol consumption.
  
  
  RESULTS
  Outcomes were significantly lower in BIG compared with CCG through 6 or 9 months, but not at 12 months: Safety belt use at 3 months (adjusted odds ratio [AOR], 0.22; 95% confidence interval [CI], 0.08 to 0.65); 6 months (AOR, 0.13; 95% CI, 0.04 to 0.42); and 9 months (AOR, 0.18; 95% CI, 0.06 to 0.56); binge drinking at 3 months (adjusted rate ratio [ARR] 0.84; 95% CI, 0.74 to 0.97) and 6 months (ARR, 0.81; 95% CI, 0.67 to 0.97); and ≥5 standard drinks/d at 3 months (AOR, 0.43; 95% CI, 0.20 to 0.91) and 6 months (AOR, 0.41; 95% CI, 0.17 to 0.98). No substantial differences were observed between BIG and NCG at 12 months.
  
  
  CONCLUSIONS
  Our findings indicate that SBIRT reduced risky driving and hazardous drinking in young adults, but its effects did not persist after 9 months. Future research should explore methods for extending the intervention effect.
authors.affiliation: School of Nursing , University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Marilyn S
authors.initials: MS
authors.lastname: Sommers
authors.forename: Michael S
authors.initials: MS
authors.lastname: Lyons
authors.forename: Jamison D
authors.initials: JD
authors.lastname: Fargo
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Sommers
authors.forename: Catherine C
authors.initials: CC
authors.lastname: McDonald
authors.forename: Jean T
authors.initials: JT
authors.lastname: Shope
authors.forename: Michael F
authors.initials: MF
authors.lastname: Fleming
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology*; D000437:Alcoholism / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology; D001334:Automobile Driving / Q000523:psychology*; D061345:Early Medical Intervention / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012309:Risk-Taking; D055815:Young Adult
keywords: Brief Intervention; Hazardous Drinking; Risky Driving